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Incorporation of Registries in Electronic Health Records (and vice versa) ASTHO Immunization Registry Summit Wednesday, August 4, 2010 Crystal City, VA. Gus Birkhead, M.D., M.P.H. Deputy Commissioner, Office of Public Health New York State Department of Health. NYS IIS History.
Incorporation of Registries in Electronic Health Records(and vice versa)ASTHO Immunization Registry Summit Wednesday, August 4, 2010Crystal City, VA
Gus Birkhead, M.D., M.P.H.
Deputy Commissioner, Office of Public Health
New York State Department of Health
New York State (outside of New York City)
Voluntary participation since 1994.
Regional registry model
Legacy system required installation of software and updates on each office computer.
Individual consent required.
New York City has mandatory registry (NYCIR) since 1997.
Effective January 1, 2008,
Mandatory reporting by health care providers of immunizations given to persons age <19 years.
Consent not required
Past immunization history must be reported if not previously reported.
With written consent, immunizations given to persons 19 years and older can be reported.
Vital records birth certificate information, including immunizations administered at birth, “seed” the NYSIIS.
Allows NYSIIS – NYCIR data exchange
As of May 1, 2010:
3.1 million patients
36.4 million immunizations
9,200+ individual users
3,100+ health care provider practices
Coverage: 78.7% of NYS children (outside of NYC) age <6 years have >2 shots in NYSIIS
NYSIIS accepts standard HL-7 messages via batch load from EHRs
Certified 56 vendors serving 664 practices, plus 141 practices using in house systems. 10 million of the 17 million annual transactions.
An additional 18 vendors are in process of certification
Exchanging with 8 managed care plans for HEDIS
Not bi-directional or real time.
Vendor by vendor/practice by practice set up.
Not all practices served by certified vendors have current EMR software or are willing to pay for NYSIIS service.
New version of HL7 2.5.1 requires upgrading NYSIIS and vendor software.
$1 billion public and private investment in the Statewide Health Information Network for New York, or SHIN-NY;
Testing the Universal Public Health Node (UPHN), a system designed facilitate bi-directional data between State DOH and local health information exchanges across the state for public health functions;
Replace batch uploads to NYSIIS from EMRs.
Integrate child health data held by state health department, to benefit providers, PH programs and children.
Initially use NYSIIS as a base
Lead laboratory results
Newborn hearing screening results
Develop an integrated system built on the statewide information infrastructure:
Newborn Metabolic Screening Program
Early Intervention (0-3 yrs) – 75,000/year
WIC (pregnant women and kids age 0-5) –
SPARCS Hospital discharge incl. ED visits
eMedNY Medicaid billing system
Physician with patient
Early intervention program services
PH Program Manager
Follow up kids with conditions of public health interest (lead)
Monitor population health
Program monitoring and administration
Child Health Information Initiative (CHI2)Overview of Integration Components
Available Data Sources
NYSDOH Systems Environment
(OTDA, OCFS, etc.)
(Hardware & software: TBD)
Source Data Access layer
CHI2 Data Access Layer
Linkages to Map Child Source Records
…Other DOH Child Health
Maximize the use of the existing information infrastructure
Develop a standard infrastructure that promotes everyday use, access and data sharing
Improve bidirectional communication
Employ standards to assure a seamless flow of information
ARRA: Funds used to accelerate work on a universal public health node to connect internal and external systems together
Health Care Reform - Meaningful use criteria, guidance and funding to support enhanced ability for clinical data to be reported, aggregated and analyzed for public health purposes.
Statewide IT policy planning
Broader thinking by Public Health about the potential for new uses of data;
Overcome barriers of silo funding/thinking;
Funding to support system upgrades is critical; for example funding is needed to upgrade to HL 7 2.5.1
New system must be developed with interoperability in mind.
Public Health will need to operate dual systems (current and new HIE-based systems) until HIE-based systems are validated and all providers have access.